Clinical Outcomes of Deep Anterior Lamellar Keratoplasty (DALK) in patients with Keratoconus: An Interventional study
Abstract
Keratoconus (KC) is a common ectasia of the cornea. Deep Anterior Lamellar Keratoplasty (DALK) is one of the modality to treat Keratoconus (KC). So this study was conducted to find out the clinical outcomes of DALK in patients with Keratoconus. For this study 33 eyes of patients with Keratoconus were operative and followed for 3, 6, 9, and 12 months to find out the clinical outcomes of DALK on various visual parameters. It was found that Best corrected Visual Acuity (BCVA) preoperative and postoperative at 3months, 6 months, 9 months and 12months were -1.106±0.160, - 0.91±0.153, -0.725±0.107, -0.631±0.172 and -0.495±0.127 respectively, which is statistically significant (p value ≤0.001). Mean Refractive Spherical Equivalent (MRSE) preoperative and postoperative at 3, 6, 9 and 12months were -7.609±1.860, -6.109±1.287, -5.156±1.110, -4.390±0.858 and -3.812±0.790 respectively, which is also significantly improving. Epithelial Cell Density (ECD) preoperative and postoperative at 3, 6, 9 and 12 months were 2159.625±85.757, 2103.218±70.393, 2065.250±77.051, 2044.250±93.637 and1998.718±11.999 respectively. It is also statistically significant. Average Keratometry preoperative and postoperative at 3, 6, 9 and 12months were 59.000±1.722, 56.578±1.492, 55.734±1.156, 54.687±1.068 and 50.187±10.314 respectively, which is also significantly decreasing. Topographic Astigmatism preoperative and postoperative at 3, 6, 9 and 12 month’s were3.968±1.046, 3.109±0.737, 2.765±0.729, 2.359±0.650 and 2.015±0.677 respectively. It is also statistically decreasing. Central Corneal Thickness (CCT) preoperative and postoperative at 3, 6, 9 and 12 months were 370.625±24.205, 502.500±9.993, 498.00±14.170, 496.562±15.576 and 492.843±14.438 respectively. CCT is also significantly improving. This concludes that outcomes of big bubble DALK in patients with KC was very effective and DALK should represent the technique of choice for surgical rehabilitation of patients with moderate to advanced KC intolerant to contact lenses.
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Introduction
Keratoconus (KC) is a common ectasia of the cornea.1-2 Its reported incidence ranges between 50-230 per 100,000 and the estimated prevalence is 54.5:100,000. Clinically, the central or paracentral corneal stroma undergoes progressive thinning and loss of structural integrity that leads to bulging of the cornea, which gives the cornea its typical cone shape appearance in Keratoconus.
Conclusion
It can be concluded from this study that big bubble DALK in patients with KC results in improvment of visual parameters like BCVA, MRSE, ECD and CCT. So it can be concluded that this big bubble DALK technique is effective in patients with keratoconus with good clinical outcomes.